Basically, things that have to do with the disposition of their remains, AND will not be overly burdensome to other people, AND do seem to be in line with their general values during life, ought not to be ignored. Other things usually can be. Exception: confessions to crimes. If someone wants to confess to a crime, and either wants a lawyer or police officer at the bedside, or wants you to record the confession, I would take this seriously. It may be a phantasm, but you only have one chance to find out.
I actually know someone who was a nurses’ aide, who recorded something on his phone that was a confession to embezzlement that settled a fraud case, and took a cloud of suspicion off an ex-employee, who was then offered a post facto severance package, after essentially being harassed out of the agency. I don’t know the person well-- just someone who goes to my synagogue, so maybe the story is being made more dramatic than it really was, but just saying.
A lot of people are in a desperate frame of mind right before death, and a lot of others are really tripping on pain killers. So people might fantasize things that they normally wouldn’t think about.
By way of comparison, I know an OB who will perform abortions on demand for regular patients who come in recently having learned they are accidentally pregnant, and for women carrying intended pregnancies that have had something go terribly wrong. (She does not advertise this service, and it is offered only to established patients). What she does not do, though, is about a 3rd trimester abortion for a woman who has been coming in regularly for check-ups for eight months, to all appearances, happy and excited about the pregnancy, then has a momentary freak-out and demands an abortion.
She gives the woman the one safe sedative that is available for the third trimester, and send her home, after making sure she won’t be alone, and has a therapist call her.
I’m just saying, women in the last few weeks of pregnancy can freak out-- I’ve been there, and I know-- and if life coming into the world can freak you out, your own life going out has to be freaky, especially if you are medicated for pain.
I’m sure a lot of “final words” need to be looked at in this context.